Healthcare Provider Details

I. General information

NPI: 1417368226
Provider Name (Legal Business Name): ANDREW GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 N HALSTED ST
CHICAGO IL
60614-5008
US

IV. Provider business mailing address

4025 N. SHERIDAN ROAD
CHICAGO IL
60613
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 773-388-1600
  • Fax: 773-388-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.144243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: